Nursing as an art

• Therapeutic communication techniques

  • Using silence
  • Providing general leads
  • Being specific and tentative
  • Using open-ended questions
  • Using touch
  • Restating/paraphrasing
  • Restating
  • Seeking clarification
  • Perception checking/seeking consensual validation
  • Offering self
  • Giving information
  • Acknowledging
  • Clarifying time/sequence
  • Presenting reality
  • Focusing
  • Reflecting
  • Summarizing/planning
• Barriers to therapeutic communication

  • Stereotyping
  • Agreeing and disagreeing
  • Being defensive
  • Challenging
  • Probing
  • Testing
  • Rejecting
  • Changing topics/subjects
  • Unwarranted reassurance
  • Passing judgment
  • Giving common advice
• Communication


  • Any means of exchanging information or feelings between two or more people
  • Basic component of human relationship
  • Intent: to obtain a response
• Purposes of communication

  • Influence others
  • Obtain information
• Modes of communication

  • Verbal communication
  • Nonverbal communication
  • Electronic communication
• Verbal communication


  • Pace and intonation
  • Simplicity
  • Clarity and brevity
  • Timing and relevance
  • Adaptability
  • Credibility
  • Humor
• Nonverbal communication


  • Body language
  • Personal appearance
  • Posture and gait
  • Facial expression
  • Gestures
• Electronic communication

  • E-mail
• Factors influencing the communication process

  • Development
  • Gender
  • Values and perceptions
  • Personal space/proxemics
  • Territoriality
  • Roles and relationship
  • Environment
  • Congruence
  • Interpersonal attitudes
  • Boundaries
• Therapeutic communication


  • Promotes understanding
  • Helps establish constructive relationship between nurse and client
  • Client centered
  • Goal directed/helping relationship
  • Active listening
  • Visibly turning in
• Helping relationship

  • Nurse-client relationship
  • Interpersonal relationship
  • Therapeutic relationship
• Phases of the helping relationship

  • Pre-interaction phase
  • Introductory/orientation/initiation phase
  • Working phase
  • Termination phase
• Pace & Intonation


  The manner of speech (rate, rhythm, tone) will modify the feeling and impact of message
• Simplicity


  • Use of commonly understood words, brevity and completeness. Avoid making shortcuts like using medical abbreviations
• Clarity


  Saying exactly what is meant
• Brevity


  Using the fewest words necessary
• Timing and Relevance


  • Words need to be heard at the appropriate time and relate to the person or their interests and concerns. Be sensitive to the client's needs and concerns
• Adaptability


  • Spoken messages need to be altered in accordance with behavioral cues from the receiver
• Credibility


  • Worthiness of belief, trustworthiness, and reliability. Reliability is developed by being consistent, dependable and honest
• Humor


  The use of humor may help clients to adjust to difficult & painful situations. This must be used with care
• Body language

  • Gestures
  • Body movements
  • Use of touch
  • Physical appearance
• Personal appearance


  • How a person dresses is often an indicator of how he feels
• Posture & gait


  • The way people walk & carry themselves are often reliable indicators of self-concept, current mood, and health
• Facial expression


  • The face is the most expressive part of the body. Eye contact is an essential element of facial communication
• Gestures


  • Hand and body gestures are expressive and communicate feelings at any given moment. Can indicate being anxious or relaxed
• Touch


  • Communicates feelings
• Sign language


  • Communicates through gestures
• Development


  • Knowledge of a client's developmental stage will allow the nurse to modify the message accordingly
• Gender


  • Girls tend to use language to seek confirmation, minimize differences, and establish intimacy. Boys use language to establish independence and negotiate status within a group
• Values


  Standards that influence behavior
• Perception


  A personal view of an event
• Personal space/Proxemics


  Personal space is the distance people prefer in interactions with others. Proxemics is the study of distance between people in their interactions
• Territoriality


  The concept of the space and things that an individual considers as belonging to the self
• Roles & Relationships


  • Affect the content and responses in the communication process. Examples: Client & Nurse, Parent & Child
• Environment


  • People usually communicate effectively in a comfortable environment
• Congruence


  • Verbal and nonverbal aspects match
• Interpersonal attitudes


  • Attitudes convey beliefs, thoughts, and feelings about people and events. Caring, warmth, respect and acceptance facilitate communication. Health care providers may unknowingly use speech that they believe shows caring but the client perceives as demeaning or patronizing (Elderspeak)
• Boundaries


  Limits of individuals, objects or relationships. Professional boundaries keep focus on the client, avoid sharing personal information, affirm professional role in the relationship
• Pre-interaction Phase


  Before the face to face meeting
• Introductory/Orientation/Initiation Phase


  Sets the tone of the relationship